How Long to Become
4-8 years
Job Outlook
6% growth from 2021-2031
Source: BLS
A registered nurse first assistant (RNFA) is a registered nurse (RN) or an advanced practice registered nurse (APRN) who works in an expanded role as a surgical first assistant. They are responsible for working with the surgical team, in surgery, at the direction of the surgeon.
An RNFA often earns a six-figure salary and can practice across the U.S. Teaching hospitals fill this role with surgical residents and fellows.
If you enjoy working in surgery, keep reading for more information about what RFNAs do, where they work, and how to become an RNFA.
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What Does an RNFA Do?
adn or bsn required
Certification required (advanced aprn role)
An RNFA uses the necessary knowledge, judgment, and skills to collaborate with the surgeon for optimal patient outcomes. These RNs’ added training can make a difference in the lives of patients under anesthesia.
RNFAs work in surgical care during the preoperative, intraoperative, and postoperative stages of surgery. They collect patient data, monitor blood loss, protect against contamination, and assess wound healing.
An RNFA is uniquely qualified to coordinate perioperative care while cutting, dissecting, or suturing under the direction of the operating surgeon. One goal of the position is maximizing the surgeon’s efficiency and minimizing the time in surgery.
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Key Responsibilities
- Assessing the patient perioperatively
- Customizing perioperative and discharge care plans
- Monitoring wound exposure
- Using instrumentation to control bleeding, suturing
- Handling postoperative dressing changes and suture removal
Career Traits
- High-stress, fast-paced environment
- Physically demanding
- Requires strong communication
- Attention to detail
Where Do RNFAs Work?
The nature of the role means RNFAs work in areas where patients are either undergoing surgery or are recovering after. Most states will not allow RNFAs to function as scrub nurses in the operating room.
RNFAs spend many hours on their feet, sometimes stationary alongside the surgeon. This increases the stress on the lower extremities and lower back.
Surgery Centers
These independent medical facilities schedule only outpatient surgeries, and do not offer overnight stays. RNFAs may have an expanded role, providing preoperative education to the patient and family and postoperative discharge education. This is in addition to the regular intraoperative surgical assistance.
Operating Room
Inside the operating room, an RNFA may provide surgical site exposure, handle or cut tissue, suture, and provide hemostasis and wound management. These are the tasks of a surgical resident or fellow at a teaching hospital. They may also prepare the surgical tools and supplies needed during surgery.
Postoperative Care Units
During the postoperative period, an RNFA may provide patient and family education on postsurgical care, including wound care. They also perform postoperative assessments to monitor for signs of complications.
How to Become an RNFA
The journey to become an RNFA begins with graduating from an accredited nursing school and passing the National Council Licensure Examination (NCLEX-RN). This is a requirement for an RN license in every state. The remaining state requirements for an RN license vary, depending on the state board of nursing.
At a minimum, nurses require a bachelor of science in nursing (BSN) education to be eligible for an RNFA program. Nurses with an associate degree in nursing (ADN) may choose to attend an RN-to-BSN program. Nurses can complete these programs online or in person.
APRN nurses with perioperative nursing experience may also choose to attend an RNFA program. The program may be offered through a school of nursing or through the National Institute of First Assisting (NIFA).
Nurses need a current unrestricted RN license, two years of experience in perioperative nursing, and a Certified Nurse Operating Room (CNOR) designation. In some programs, the nurse may earn the CNOR certification during the program.
Whatever program the candidate chooses, the Association of periOperative Registered Nurses (AORN) must approve it. Nurses may then sit for the certification examination administered by the National Assistant at Surgery Certification (NASC). After passing the certification, the RNFA may use the designation of CRNFA.
How Much Do RNFAs Make?
According to June 2022 Payscale data, the average hourly pay of a small sample of RNFAs is $36.70, and their average annual base salary is $104,000. Based on survey responses, approximately 70% of the practicing RNFAs are female.
Several factors can influence the salary range of RNFAs. These include advanced education, such as an APRN, or additional education or certification pertinent to working in surgery.
Years of experience also influence salary potential. Nurses who want to earn more as an RNFA in a shorter window of time can also consider moving or changing their practice setting.
Frequently Asked Questions About RNFAs
How long does it take to become an RNFA?
It can take up to four years to earn a BSN degree. The RNFA candidate then needs an additional two years of experience in perioperative nursing before being admitted to and completing an RNFA program. With time to study for the certification examination, it could take up to seven years to become an RNFA.
What’s the difference between an RNFA and a perioperative nurse?
A perioperative nurse helps patients and families complete paperwork before surgery, helps monitor the patient’s condition during and after surgery, and helps maintain the instruments. While an RNFA can assist with those tasks, they also work side by side with the surgeon, assist with making incisions and suturing, and help control bleeding during surgery.
Can RNFAs perform surgery?
No. An RNFA can assist during surgery with dissection and suturing, but only under the supervision of the surgeon.
What states recognize RNFA?
All 50 states in the U.S. recognize the role of an RNFA within the state’s RN scope of practice. An RNFA can be a BSN-prepared or APRN nurse.
Page last reviewed September 5, 2022
